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Struggling with 3 week old (long)

I had my 4th baby 3 weeks ago today. It was my 4th C-section. I have had issues with all my babies breastfeeding in the early days/weeks, but have overcome them and successfully nursed (#2 for 2.5 years and #3 for 3+ years). This time things are different and I am really struggling.

The baby was 8.15 at birth, which was considered large for gestational age- so we were slapped with needing blood sugars drawn before I could put him on the breast for 24+ hours (turned out being nearly 36 hours) (which takes out a lot of the spontaneity when you have to wait for a nurse to come and prick his heel before you are "allowed" to breastfeed). He latched well from the beginning and appeared to be sucking well, I had absolutely no concerns. The first night his blood sugars started to drop, one time he was at 35 and they told me 34 got him into the NICU. I had a ton of nurses in the room- passing him from one to the other. They said he needed formula and I said no, I would like donor milk. That really irritated them- like I was risking his life waiting for them to have to unthaw it. They bring it in a bottle and I said I would prefer a syringe. In the meantime I start trying to pump as much colostrum as I can. He really does not like the donor breastmilk and struggles taking it. At the next check his sugar was up to 48, but when I want to nurse him again and they check he is down to 32. At this point we have the NICU nurse, neonatal nurse practitioner, and charge nurse in our room telling us that we must give him formula by bottle, where he has to exert no energy (and they told me I would not be able to breastfeed him at that time because it burned too many calories/lowering his sugar), or they will take him to the NICU. He was refusing to swallow anything and they are forcing 30+ cc's down his throat. Anyway- it was a nightmare of a night- they didn't take him to NICU and our next shift nurse told us to just to skin to skin and not stress him out and his sugars came up beautifully, but they still had to be checked before he could latch.

We were discharged 3 days later. He had lost 10% of his weight and was down to 8.0 pounds. He was having some urate crystals in his diaper, which they were just calling concentrated urine and said it was normal until my milk was fully in. My milk came in on day 3/4 but it was not as dramatic as it usually is. I did have some engorgement, but not as long or as bad as I have had in the past. I just kept nursing, which was difficult because he was incredibly sleepy and hard to wake. Went to a check up at 5 days old and he was the same weight, 8.0. Called an IBCLC and she said to supplement (with expressed milk) after feeds. I was incredibly hesitant since my other babies had nursing troubles in the early days but I never had to supplement. But I did, and 2 days later at one week old he was 8.3. Dr. was happy. I still wasn't comfortable with the supplementing (bottles) so we were doing a few a day but I was really trying to just nurse. At 10 days old I noticed he did not seem to be any bigger and had my husband go out and buy a scale. On that scale he was back down to 8.0. So for the next 2 days we supplemented (again, breastmilk) and at his 12 day well child check he was 8.3 again, which was no weight gain in a week. (and my scale has proven to be within 1/2 oz of the Dr's scale every time)

At 13 days old the IBCLC came to my home to do before and after weights. She said he needed to be taking 2.5 oz per feed, and he only took 1.5oz from me during that session. (He was also dealing with some jaundice- was around 14 at this point) I rented a Medela Symphony and she wanted me pumping 20 minutes after every day time feed to boost my supply (which is 5-6 times a day) and supplement 2oz after every day time feed as well. She also had me start fenugreek and More Milk Plus. I started that and at his weight check 2 days ago (19 days old) he was up to 8.9. She didn't (and still doesn't) want me doing anything during the night other than nurse. Dr. was happy with the gain and is fine not seeing him until his 1 month appt.

I talked to the IBCLC after the appt. Monday (where he was 8.9) and she said great- we will start trying to slow down the supplements, maybe every other feed. She will come this Friday for another before/after weight to see if he is more efficient at removing the milk from the breast. I pump around 12 oz a day after feeds, which enough to cover all the supplements. He has received no formula since that first night in the hospital.

Well, it is now Wednesday and he has not pooped since very early Monday morning. I called the IBCLC yesterday and she said she is okay with that, that maybe I ate something that is constipating him or maybe he is absorbing it all and will have a big weight gain. I weighed him yesterday and today and he is exactly the same (on my scale) as he was on Monday. So, no weight gain in 2 days and no poop. I have still supplemented 5 times (10 oz) Monday and Tuesday.

What could be going on? He latches and I hear him suck and swallow, although there are times he doesn't. I have nursed for long enough to know the difference. But there are times he does really great.

Being on this schedule (and I have 3 other kids in the house, and my help has all gone) of nursing/pumping for 20 minutes/supplementing with a bottle (and I do have a SNS but find it very cumbersome and difficult to use) makes it very hard to just go with the flow and allow him to nurse and cluster feed. In the evenings I have been trying to just lay with him and allow him to just stay latched on, whether he is actively nursing or just sleeping, but honestly I feel like I am drowning and I don't know how to fix this. I have always dealt with oversupply in the past- and I have no clue if I have a supply issue or if it is okay- but he isn't gaining weight well, even being supplemented so I am leaning towards a supply issue. I have always had an overactive letdown- and this time I only feel the let down sometimes and it is very mild compared to what I am used to. I have shed so many tears over this and just want and need for this to work. But I cannot continue to be a slave to this schedule, where I feel I cannot leave the house for fear that it interrupts the nursing/pumping/supplement schedule.

Anyway- does anyone have any thoughts or advice? My biggest concern now is the lack of poop- he had been pooping in every diaper. He still tends to be a sleepy baby, but is awake more than he used to be. Most every night I am waking him in the night to nurse, although last night he did wake up himself. I would say that we are nursing 8-9 times a day, which I know is on the low end- but he is also getting 10 oz in supplements and I am pumping 100 minutes a day.

Re: Struggling with 3 week old (long)

My goodness, you must be exhausted! Is there any way you can get some help around the house? At this point, you shouldn't be doing more than caring for the baby and yourself, particularly because this is your 4th(!!!) c-section. The recovery period should be expected to be much longer than your 1st or 2nd surgery.

I'm thinking that you might really benefit from using a professional scale. I know your scale matches wheat the scale at the doc's office tells you, but I think you need a scale that's accurate to the 1/10th of an oz. If you had a scale like that, you could do your own before-and-after weights, just like the ones the LC does. The problem with having the LC do the weights is that milk intake at any given feeding can vary a lot. A day or two's worth of data allows you to find out what the baby's average intake is, and that's really a lot more relevant than what he does at any individual feed. So ask the LC if she will rent you a scale, or if she knows where you can rent one. Once you have the data, you know where you are- do you need to continue to supplement, or not?

Re: Struggling with 3 week old (long)

Thanks- I did have help for the first 2 weeks, but they are gone now and my husband is back at work. It is what it is at this point, unfortunately. I have many friends bringing us meals almost every night so we are very fortunate there.

Interesting about a professional scale. Hadn't even thought of that- my scale only reads in 1/2 oz. increments.

I just want (need) for this to work and can't figure out why it isn't.

Re: Struggling with 3 week old (long)

I totally understand!!! The search for the elusive explanation... If you knew why the baby wasn't gaining well, you'd know how to go about fixing it. This is why I'm gung-ho about the professional scale. It would allow you to figure out exactly how much milk baby is getting. If he's getting sufficient milk and the super-accurate scale says that his weight is increasing by 0.5-1 oz per day, then you know that there's most likely no problem, and the next weigh-in should show normal gain. If the weigh-in doesn't match what you're seeing on your scale at home, then maybe you're looking at scale error at the pediatrician's office. If he's taking in only small amounts- say 1-2 oz instead of 2-3, on average- then you know you need to work on his latch and make sure he nurses more frequently. If you nurse more often and the baby's latch seems fine, then maybe you need to start looking into possible causes of low supply- things like bits of retained placenta, a bad reaction to hormonal contraception (if you're using that), thyroid problems, etc.

ETA: since this is your 4th c-section, I'm thinking that it might make sense to call you obstetrician and discuss the condition of your placenta. Placenta problems- e.g. placenta accreta, placenta percreta- are more likely in women with previous c-sections. And an issue like accreta or percreta could make it more likely that the placenta would fragment during removal, leaving a shred inside. That shred would go on producing pregnancy hormones, convincing your body that it's still a little bit pregnant, and potentially damping down on your milk supply.

Re: Struggling with 3 week old (long)

Sounds very similar to my experience with my third born on sept 12 th via csection. He spent three days in nicu for low blood sugars. It was a horrible experience meant for another thread. It was so bad my husband and I were debating having him transferred to another hospital. They stuffed him full of formula and had him on a glucose drip and fortified my pumped milk. So upon leaving he was at birth weight 10.3.

At two week check he was down to 9.15. Pedi was not concerned, I had successfully ebf my other two. (tandem nursing right now) at three weeks he was down to 9.10. Pedi still not worried. But I became concerned because I realized he wasn't having enough poop and pee diapers. I finally figured out that he was a lazy nurser and I was letting him because the older two kiddos (2 and 4) needed me. I was so tired at night I wasn't using all the tricks to keep awake and nursing. So I made a concerted effort to pay more attention and really give him the time he needed at the breast. That worked and he has passed his birth weight.

Sorry I am so long winded...just wanted to share and offer some encouragement. I was really doubting myself early on in my little guys life.